PROJECT SUMMARY Ambulance-based telemedicine can permit stroke consultations enroute to the hospital, and rapidly identify and triage stroke patients to decrease the time between first provider contact and definitive therapy. Ambulances are being equipped with low-cost telemedicine systems consisting of a laptop is connected to the Internet through a wireless router combined with a web-camera and a speaker on the upper part of the ambulance for physician monitoring of the patient and consultation with the attending Emergency Medical Technician (EMT)/pre-hospital provider. There is a need to i) understand the cognitive, physical and temporal demands on caregiving teams in geographically dispersed remote locations, and ii) evaluate the potential for user/design errors that characterize the use of these Information Technology (IT) systems in high-stress environments. Few studies have been undertaken to assess the process flow, workload and usability issues associated with ambulance-based telemedicine systems to evaluate and provide the requisite treatment to stroke patients in transit to the hospital. The recommendations and guidelines developed from the proposed research is expected to enhance the efficiency of low-cost telemedicine system in ambulances, for expansion throughout South Carolina to reduce the percentage of stroke patients that die outside of the hospital.